Hemosorption in the treatment of bronchial asthma

Hemosorption is considered as a method of detoxification (with the passage of blood through the hemosorbent the toxins are removed) and immunocorrection (the function of lymphocytes and phagocytes is activated, the number of receptors to cortisol on the surface of the lymphocyte membranes is increased).

Hemosorption was effective in atonic bronchial asthma, including polyvalent allergies and cortico-dependent corticore-resistant bronchial asthma. After hemosorption, the effectiveness of drug therapy is increased.

Hemosorption is often effective in persons with an unidentified allergen. After hemosorption, it is possible to identify the "culprit" of allergy (ie, the cause of bronchial asthma). Hemosorption is contraindicated in exacerbating the infection in the bronchopulmonary system.

Extracorporeal immunosorption

Extracorporeal immunosorption is a method based on the removal of specific IgE-reactants from the bloodstream when blood is passed through a sorbent, on which the allergen of house dust and timothy pollens is immobilized. Specific IgE react with allergens and precipitate on the sorbent. The method is indicated for severe atopic bronchial asthma, low effectiveness of specific immunotherapy and traditional treatment of the disease. Extracorporeal immunosorption also contributes to an increase in the number of beta-adrenergic receptors in the bronchi.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Monoclonal anti-IgE immunosorption

Monoclonal anti-IgE immunosorption consists in removing a patient from the body of a reactant when passing blood through a sorbent containing monoclonal antibodies to IgE. This method can be used in patients with bronchial asthma, sensitized to a large number of allergens, for the same indications as extracorporeal immunosorption.

Plasmapheresis

Plasmapheresis - removal of the patient's plasma (along with it, the reactants are removed) and replacing it with a plasma substitute. The method is used for severe, resistant to treatment forms of bronchial asthma.

Mechanism of therapeutic action of plasmapheresis:

• desintoxication;
• immunocorrecting effect;
• correction of rheological properties of blood and improvement of microcirculation in the lungs;
• increased activity of glucocorticoid receptors in bronchi;
• reduction of the inflammatory process in the bronchi (primarily the eosinophilic component of inflammation);
• increased blood saturation with oxygen;
• increasing the sensitivity of the cells of the bronchopulmonary system to therapeutic measures.

The volume of the removed plasma is 30-40% of the volume of plasma circulating in the bloodstream. The volume of the plasma substitute exceeds the volume of the removed plasma by 30%. 2-5 procedures of plasmapheresis are carried out with intervals of 2-3 days.

The method of plasmapheresis can be used for all variants of bronchial asthma, but it is most effective in the atonic form of the disease. Plasmapheresis is also highly effective for asthmatic status in combination with pulse therapy with prednisolone.

Contraindications to plasmapheresis:

• absolute - epilepsy, inclination to thrombosis;
• relative - age over 60 years, circulatory failure II B and III st; anemia; hypotension; disturbances of a warm rhythm.

Lymphocytapheresis, thrombocytopheresis and enterosorption

Lymphocytapheresis - removal of cytotoxic lymphocytes from the blood by its gravity. The indications are the same as for plasmapheresis.

Thrombocytopheresis - removal of blood from platelets. Platelets play an important pathogenetic role in the development of bronchial asthma. In patients with bronchial asthma, there was an increase in platelet aggregation, disturbance of microcirculation. Platelets, along with mast cells, alveolar macrophages, eosinophils produce a platelet activating factor (FAT), which contributes to the development of bronchospasm, cell infiltration and edema of the bronchial mucosa.

Thrombocytopheresis is effective in 90% of patients with atopic bronchial asthma. The therapeutic effect of thrombocytoperesis is due to the normalization of the aggregation capacity of platelets, the decrease in their release of FAT, involved in the development of inflammation in bronchial asthma.

Enterosorption is most widely used in the treatment of atopic bronchial asthma caused by drug and food allergies.